Mitral Valve Repair and Replacement

Mitral valve surgery is used to help correct a damaged mitral valve so that it returns to its function of regulating blood flow between the left heart chambers. Either open-heart surgery or a minimally invasive procedure can be used to repair the damaged mitral valve.

The heart has four valves that control the flow of blood to the heart: the aortic, mitral, tricuspid and pulmonic (pulmonary) valves. Two common mitral valve conditions caused by heart valve disease are:

  • Mitral valve prolapse. When the valve's flaps do not fully close, the blood leaks backward. In the case of mitral valve prolapse, a decrease in heart function can occur, and the potential for an irregular heartbeat and permanent heart damage increases
  • Mitral valve stenosis. When the opening of the valve narrows—whether from disease, infection or genetics—the valve reduces blood flow within the heart, potentially causing heart rhythm issues and increasing the chance of a stroke

The Benefit of High-Volume Expertise

Cardiac surgeons at the Brigham and Women’s Hospital Heart & Vascular Center are high-volume performers in all types of heart valve surgery, including mitral valve repair and mitral valve replacement. Our team has performed over 4,000 mitral valve repairs since 1971. In 1996, we launched our minimally invasive mitral valve repair surgery program and have performed over 1,000 since then. In total, we've performed over 2,600 minimally invasive valve surgeries.

Our experienced surgeons, in collaboration with a multidisciplinary team of specialists through the Structural Heart Disease Program, handle the most complicated cases with a range of treatment options that improve the lives of cardiac surgery patients throughout the world. These include procedures that allow patients to avoid the use of long-term anticoagulants and procedures that are minimally invasive, offering faster recovery with less pain.

With 47,000 outpatient visits each year, the Heart & Vascular Center is one of the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.

Mitral Valve Repair and Replacement FAQs

When Should I Have Mitral Valve Repair or Replacement Surgery?

Mitral valve disease can force the heart to pump harder to regulate blood flow throughout the body. Choosing mitral valve repair or mitral valve replacement can improve quality of life and reduce the risk of life-threatening heart issues that may arise if left untreated.

Surgery may be recommended on your mitral valve if you have:

  • Mitral regurgitation
  • Mitral stenosis
  • A valve that has developed an infection (endocarditis)
  • Severe mitral valve prolapse that is not controlled with medicine
  • Heart failure symptoms, such as chest pain, shortness of breath, fainting spells or heart failure
  • Tests show that the changes in your mitral valve are affecting heart function
How is Mitral Valve Surgery Done?

Deciding whether you need a mitral valve repair or a mitral valve replacement is based on the severity, progression and risk factors of the disease. Mitral valve replacement is chosen only in the most severe cases. Medication may offer the first step in regulating a mitral valve, followed by a mitral valve repair procedure, which offers less risk and a quicker recovery. A fully replaced valve will require additional checkups over the life of the valve.

Mitral Valve Repair Surgery

Mitral valve repair surgery corrects an improperly functioning mitral valve. Cardiac surgeons at Brigham and Women’s Heart & Vascular Center offer a variety of surgical techniques to repair heart valves to enable them to open and shut efficiently. The main mitral valve repair techniques are:

  • Annuloplasty, which tightens the ring around the valve. Repair of structural support to reshape fibrous strings that support the valves or the fibrous ring that supports the valve (the annulus)
  • Valvuloplasty, which uses a balloon at the end of a catheter to expand the mitral valve when inflated. Reshaping the valve leaflets allows the valve to open and close better
  • Mitral valve clip, which attaches a clip to a catheter to repair a leaky valve and patch holes
  • Decalcification to remove calcium to prevent leakage

Mitral Valve Replacement Surgery

When your surgeon determines that your heart valve cannot be repaired, they may recommend mitral valve replacement surgery. Damaged heart valves are replaced with a choice of substitute valves, including:

  • Mechanical valves made of durable synthetic materials such as graphite and pyrolytic carbon. These last up to 30 years, and recipients must take lifelong blood-thinning medications
  • Biological valves last for 10 to 20 years and are made from animal tissue or donated human tissue. A homograft is a valve from a donated human heart. Patients do not require long-term blood-thinning medications

Minimally Invasive Mitral Valve Repair and Replacement Surgery

Mitral valve repair or replacement surgery may be performed with minimally invasive cardiac surgery or traditional (open) heart surgery. Surgeons in the Heart & Vascular Center use their advanced training and experience to perform varied surgical options—unique to each patient—when operating on heart valves.

Brigham and Women’s Hospital has particular experience and expertise in endoscopic mitral valve surgery, a minimally invasive approach that uses small incisions on the right side of the chest. Our surgeons are ranked among the world’s leading performers of mini-thoracotomy procedures.

Minimally invasive mitral valve repair uses small incisions and has fewer post-operative complications, allowing patients to recuperate faster with less pain. The types of incisions include:

  • Mini thoracotomy, a small incision through the ribs
  • Mini sternotomy, a small opening from the top of the breastbone to the third rib

Open Mitral Valve Surgery

Open heart surgery for mitral valve replacement includes cutting skin and tissues with a wide incision so that the surgeon has a full view of the heart. Types of open surgery are:

  • Sternotomy, which involves a nine-inch incision made down the center of the chest to separate it from the breastbone
  • Thoracotomy, which involves a nine-inch incision made in the rib cage from under the arm around to the back
  • Open heart surgery, which requires a longer hospital stay and long-term care of the replaced valve
What Are the Risks of Mitral Valve Repair or Replacement Surgery?

Mitral valve procedures are generally considered highly safe. Patients who are not experiencing symptoms have the least risk, and symptomatic patients have a risk well under 1%. Possible complications include:

  • Bleeding
  • Blood clots
  • Irregular heartbeats
  • Infection
  • Stroke
  • Death
  • Malfunction of a replacement valve
Mitral Valve Repair vs. Replacement: Which Is Best?

A mitral valve repair provides patients some advantages over a mitral valve replacement surgery. Following a valve repair, nine out of 10 patients remain free of a second operation for at least 20 years. The benefits of repair vs. replacement include:

  • A longer life expectancy through improved near-term and long-term survival
  • Enhanced quality of life
  • Lower risk of complications, such as infection and stroke
  • No need for continued blood thinner medication
  • Protection of natural heart function

What to Expect at the Heart & Vascular Center

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from Brigham and Women’s main 75 Francis St. entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

Prior to surgery, you will be scheduled for a visit to the Watkins Clinic in the Shapiro Cardiovascular Center for preoperative information and tests.

The day of surgery, your care will be provided by surgeons, anesthesiologists and nurses who specialize in mitral valve disease. The Heart & Vascular Center is home to one of the most advanced hybrid operating rooms in the country. After surgery, you will recover in the post-surgical care unit, where you will receive comprehensive care from an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center, where staff members will provide surgery updates.

Multidisciplinary Care

In addition to our cardiac surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists and anesthesiologists, all experts in cardiovascular disease. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

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